Devices and methods for tissue severing and removal

Abstract

The present invention relates to devices and methods that enhance the accuracy of lesion excision, through severing, capturing and removal of a lesion within soft tissue. Furthermore, the present invention relates to devices and methods for the excision of breast tissue based on the internal anatomy of the breast gland. A tissue severing device generally comprises a guide having at least one lumen and a cutting tool contained within the lumen. The cutting tool is capable of extending from the lumen and forming an adjustable cutting loop. The cutting loop may be widened or narrowed and the angle between the loop extension axis and the guide axis may be varied. Optional tissue marker and tissue collector may additionally be provided. A method for excising a mass of tissue from a patient is also provided. The device and method are particularly useful for excising a lesion from a human breast, e.g., through the excision and removal of a part of a breast lobe, an entire breast lobe or a breast lobe plus surrounding adjacent tissue.

1 . A tissue severing device, comprising: 
 a guide comprising two co-linear, co-extensive guide lumens longitudinally extending from a proximal region to a distal terminus along a guide axis, wherein the guide lumens have co-extensive distal segments terminating in distal tips and the angle of each distal segment in relation to the guide axis is generally fixed;    a cutting tool contained within the guide and capable of forming a cutting loop extending from the distal tips of the two guide lumens, said cutting loop having a loop extension axis defined by the direction in which the cutting loop extends; and    an extension means for controlling the degree to which the cutting loop extends from the guide.    
     
     
         2 . The device of  claim 1 , wherein said distal tips are at a generally fixed distance therebetween such that the width of the cutting loop when the cutting loop is extended is generally fixed.  
     
     
         3 . The device of  claim 1 , wherein the angles between each distal segment and the guide axis are one of the same and different.  
     
     
         4 . The device of  claim 1 , further comprising a width adjuster for selectively moving the distal tips of the distal segments relative to each other to thereby selectively adjust the width of the cutting loop.  
     
     
         5 . The device of  claim 4 , wherein said width adjuster moves the distal tips of the distal segments and varies the distance between the distal tips by rotating at least one of the guide lumens.  
     
     
         6 . The device of  claim 4 , further comprising a handle at the proximal region of the guide, said handle comprising the extension means and the width adjuster.  
     
     
         7 . The device of  claim 1 , wherein the cutting tool comprises an electrically conductive material.  
     
     
         8 . The device of  claim 7 , wherein the electrically conductive material is a metallic material selected from the group consisting of a metal, a metal alloy, a metal laminate, and a metal composite.  
     
     
         9 . The device of  claim 8 , wherein the metallic material is one of titanium, titanium alloy, nickel-titanium alloy, nickel-chromium, and iron-chromium alloy.  
     
     
         10 . The device of  claim 7 , wherein the cutting tool is operatively coupled to an energy source.  
     
     
         11 . The device of  claim 10 , wherein the energy source is one of a heat source, a radio frequency energy source, and an ultrasonic energy source.  
     
     
         12 . The device of  claim 10 , wherein the energy source is a radio frequency energy source and the cutting tool is a component of a monopolar or a bipolar system.  
     
     
         13 . The device of  claim 1 , wherein the cutting tool has a predetermined cross-sectional shape.  
     
     
         14 . The device of  claim 1 , wherein the cutting tool has a cutting edge and a trailing edge.  
     
     
         15 . The device of  claim 14 , wherein the cutting edge is at least one of sharpened and serrated.  
     
     
         16 . The device of  claim 14 , further comprising a vibration-providing means for inducing mechanical vibration of the cutting tool.  
     
     
         17 . The device of  claim 1 , wherein the guide lumens comprise an electrically insulating material.  
     
     
         18 . The device of  claim 1 , further comprising a tissue collector for collecting and removing tissue severed by the cutting tool.  
     
     
         19 . The device of  claim 18 , further comprising a tissue collector controller for controlling said tissue collector.  
     
     
         20 . The device of  claim 18 , wherein the tissue collector is adapted to collect tissue at least one of as the tissue is being severed and after the tissue is severed.  
     
     
         21 . The device of  claim 18 , wherein the tissue collector comprises a tissue collection bag, said collection bag being one of directly and indirectly attached to the distal terminus of the guide.  
     
     
         22 . The device of  claim 21 , further comprising means for opening and closing the tissue collection bag.  
     
     
         23 . The device of  claim 21 , wherein said tissue collection bag is attached to said cutting tool whereby increasing and decreasing the size of said cutting loop opens and closes said tissue collection bag, respectively.  
     
     
         24 . The device of  claim 21 , wherein said tissue collection bag is electrically insulated from said cutting tool.  
     
     
         25 . The device of  claim 21 , wherein said collection bag is deployable and adjustable independent of said cutting tool and wherein said tissue collector further comprises a collection loop adapted to be selectively opened and closed.  
     
     
         26 . The device of  claim 21 , wherein said tissue collector further comprises a tissue collection loop adapted to be selectively opened and closed and two tissue collection lumens having collection distal tips from which said collection loop extends, said tissue collection bag being attached to said tissue collection loop.  
     
     
         27 . The device of  claim 26 , wherein said collection loop is aligned with said cutting loop.  
     
     
         28 . The device of  claim 21 , wherein the collection bag comprises an impermeable material.  
     
     
         29 . The device of  claim 28 , wherein the impermeable material is selected from the group consisting of polyethylene, polypropylene, polybutylene, polyamide, polyimide, polyester, polyvinyl chloride, polyvinyl fluoride, polyvinylidene fluoride, polycarbonate, and polytetrafluoroethylene.  
     
     
         30 . The device of  claim 1 , further comprising a tissue marker, said tissue marker configured to mark tissue severed by the cutting tool.  
     
     
         31 . The device of  claim 30 , wherein the tissue marker is in electrical communication with an external energy source.  
     
     
         32 . The device of  claim 31 , wherein the external energy source is a radio frequency energy source.  
     
     
         33 . The device of  claim 32 , wherein the tissue marker comprises means for charring or creating blackened marks on the surface of the severed tissue.  
     
     
         34 . The device of  claim 33 , wherein the tissue marker comprises marking segments extending from a trailing edge of said cutting loop.  
     
     
         35 . The device of  claim 34 , wherein the marking segments comprise a metallic material.  
     
     
         36 . The device of  claim 34 , wherein the marking segments are asymmetrically arranged along the trailing edge of the cutting loop.  
     
     
         37 . The device of  claim 34 , wherein the marking segments comprise electrically conductive wires.  
     
     
         38 . The device of  claim 37 , wherein at least some of the electrically conductive wires are interwoven to create a pattern asymmetrically arranged along the trailing edge of the cutting loop.  
     
     
         39 . The device of  claim 34 , wherein the marking segments comprise extensions of the cutting loop asymmetrically arranged thereon.  
     
     
         40 . The device of  claim 30 , wherein the tissue marker comprises a dye for staining the severed tissue.  
     
     
         41 . The device of  claim 40 , wherein the dye is located on a plurality of regions on the interior surface of one of a collection bag and the cutting loop.  
     
     
         42 . The device of  claim 41 , wherein the individual regions of dye are arranged in an asymmetric pattern on the interior surface of one of the collection bag and the cutting loop.  
     
     
         43 . The device of  claim 40 , wherein the collection bag comprises an opening, said opening containing the dye in individual regions thereon.  
     
     
         44 . The device of  claim 40 , wherein said dye is of at least two different colors.  
     
     
         45 . The device of  claim 1 , wherein the guide lumens are affixed to each other.  
     
     
         46 . The device of  claim 1 , wherein the guide lumens are housed in a tubular shaft, said tubular shaft having a distal end and a proximal end.  
     
     
         47 . The device of  claim 46 , wherein the tubular shaft further includes at least one accessory lumen.  
     
     
         48 . The device of  claim 47 , further comprising a tissue collector for collecting and removing tissue severed by the cutting tool, said tissue collector being contained in one of the at least one accessory lumen.  
     
     
         49 . The device of  claim 48 , wherein the tubular shaft has at least one opening at the distal end and wherein the tissue collector is adapted to extend from and retract into the tubular shaft through one of the at least one opening at the distal end.  
     
     
         50 . The device of  claim 47 , wherein the at least one accessory lumen comprises at least one transport lumen that allows a material to be transported therethrough to the distal end.  
     
     
         51 . The device of  claim 50 , further comprising a source of gas, liquid or a combination thereof in fluid communication with the at least one accessory lumen.  
     
     
         52 . The device of  claim 50 , wherein the at least one accessory lumen additionally comprises at least one vacuum lumen operatively connected to a vacuum source.  
     
     
         53 . The device of  claim 47 , wherein the at least one accessory lumen comprises at least one vacuum lumen operatively connected to a vacuum source.  
     
     
         54 . The device of  claim 46 , further comprising a tissue penetration means for facilitating tissue penetration, said tissue penetration means being attached to said distal end of said tubular shaft.  
     
     
         55 . The device of  claim 54 , wherein the tissue penetration means comprises at least one of a sharpened edge and a sharpened tip.  
     
     
         56 . The device of  claim 54 , wherein the tissue penetration means is operatively coupled to an external energy source.  
     
     
         57 . The device of  claim 56 , wherein the external energy source is one of a radio frequency energy source and an ultrasonic energy source.  
     
     
         58 . The device of  claim 57 , wherein the external energy source is the radio frequency energy source and the tissue penetration means is a component of a monopolar or a bipolar system.  
     
     
         59 . The device of  claim 46 , wherein the tubular shaft has a primary window near the distal end.  
     
     
         60 . The device of  claim 59 , wherein the distal tips of the guide lumens are aligned with the primary window and the cutting tool is adapted to extend and retract therethrough.  
     
     
         61 . The device of  claim 60 , further comprising a tissue collector adapted to collect and remove severed tissue, said tissue collector being contained in the primary window and extendible therefrom.  
     
     
         62 . The device of  claim 61 , wherein said tissue collector comprises a tissue collection loop, a tissue collection bag attached thereto, and two tissue collection lumens having collection distal tips from which said tissue collection loop extends, said tissue collection loop adapted to be selectively opened and closed.  
     
     
         63 . The device of  claim 59 , wherein said tubular shaft comprises a sliding cover for selectively uncovering and covering said primary window.  
     
     
         64 . The device of  claim 63 , further comprising a cover controller for selectively controlling the position of the sliding cover with respect to the primary window.  
     
     
         65 . The device of  claim 59 , wherein the tubular shaft has an additional window near the distal end of the tubular shaft adjacent to the primary window.  
     
     
         66 . The device of  claim 65 , further comprising a tissue collector for collecting and removing tissue severed by the cutting tool, said tissue collector being contained in the additional window.  
     
     
         67 . The device of  claim 66 , wherein the tissue collector is extendible and retractable through said additional window.  
     
     
         68 . The device of  claim 67 , wherein said tubular shaft comprises a sliding cover for selectively uncovering and covering at least one of said primary window and said additional window.  
     
     
         69 . The device of  claim 68 , further comprising a cover controller for selectively controlling the position of the cover with respect to at least one of the primary window and the additional window.  
     
     
         70 . The device of  claim 46 , wherein the tubular shaft has at least one opening at the distal end and wherein the guide lumens are adapted to extend from and retract into the tubular shaft through at least one of the at least one opening at the distal end.  
     
     
         71 . The device of  claim 70 , further comprising an extension-retraction controller adapted to extend and retract the guide lumens with respect the tubular shaft  
     
     
         72 - 123 . (Canceled)